Four out of five people who end up using heroin or fentanyl got their start with prescription opioids, some of which were prescribed to friends and family, according to Travis Harker, the chief medical officer at Granite Health.

“Most of the time, people put them in their medicine cabinet for a rainy day and we know that that’s where a lot of people get their start,” Harker said.

That’s why surgery patients at five hospitals in the Granite Health partnership will receive a Deterra deactivation pouch, which renders 99 percent of any leftover drugs useless.

How it works

John Mulcahy is the vice president of sales at Verde Technologies, the company that developed the Deterra deactivation pouch. He said it’s only been on the market for a few years, but it’s unique.

The company developed a special patented form of activated carbon that has just the right size pores to ensure it bonds chemically with any organic compounds in prescription medications. The process, called adsorption, essentially turns the drugs into carbon and short-circuits any potency the drug once had.

“Once that bond is made that drug will not induce any kind of reaction,” Mulcahy said.

Using the pouch is simple. You simply place unused pills, patches or liquids into the pouch, fill it up halfway with warm water, seal it and gently shake the bag before throwing it in the regular trash.

The Zero Left Campaign

The current effort to introduce the pouches in New Hampshire has been championed by Jim and Jeanne Moser of East Kingston. They founded the Zero Left Campaign after their son Adam died of a fentanyl overdose in 2015.

Moser said Adam kept his addiction a secret but it seems clear it started with pills. Moser, a surgical technician who has had several surgeries himself, said they never gave leftover opioids the fear and respect they deserved.

“We kept them in the kitchen spin-around … just right next to the vitamins and Tylenol and cake-decorating supplies,” Moser said.

In retrospect, he wonders how he could be so careless, but there was a lack of education on the risks of prescription opioids, even among medical providers.

Moser learned about Deterra pouches from a news article and began his quest to get the pouches to New Hampshire by working with Dr. Thomas McGovern at Exeter Hospital, who was already distributing the pouches to his own patients. Over the course of two months, McGovern recorded 1,150 pills disposed of through these bags. And that’s just what patients self-reported.

Moser points out that opioids are a necessary painkiller for many post-surgical rehab scenarios; two weeks after his son died, Moser had to get a knee replacement, which required opioids to manage the pain.

“It’s just that when they do go home, they need to go home with respect, regard and a way to dispose of them safely,” he said.

Pilot program

Recently, Granite Health received a $75,000 grant from Tufts Health Freedom Plan and Northeast Delta Dental that will be used for three initiatives. Granite Health will offer provider education on the new prescribing rules in the state and the difference between chronic pain and acute pain. Three of the member hospitals — Catholic Medical Center in Manchester, LRGHealthcare in Laconia and Wentworth-Douglass in Dover — will install drug take-back boxes. And all five member facilities, which will include Exeter Health Resources and Southern New Hampshire Health, will distribute 15,000 deactivation pouches to surgery patients who get an opioid prescription.

Harker said the plan was to essentially scale up the model spearheaded by McGovern at Exeter Hospital. He said the focus on surgery patients is because everyone responds differently to the same operation or the same drug. Some require a lot of pills, others only a few. It’s that variability that often leads to a significant amount of leftovers.

Part of the challenge will be to gather more information so providers can size their prescriptions more appropriately. Another goal is to make sure providers are educating their patients on the risks of prescription opioids.

Harker said the pouches serve as a helpful educational prop.

“It’s more than just giving them a packet or a pouch to put their medications in; it’s a way to facilitate a conversation about the risks of keeping unused opioids in your home. ... That is kind of the magic in this,” he said.